Transcript Health literacy - national health literacy action group

Taking Action on Health Literacy
CPD Session 5th December 2011
Alastair Pringle, Head of Patient Focus & Equalities, SG
Kate Burton, Public Health Practitioner, NHS Lothian
Catriona Carson, Health Improvement Lead for Literacies, NHS
Greater Glasgow and Clyde
today
• Background
• The theory - Catriona
• The practice - Kate
• What next?
background
• Health Improvement & Patient Focus get our heads together – we
know there is a problem….
• Scoping Study 2008/9 recommends ‘focus on the practical integration
of the ideas underpinning health literacy into existing programmes,
projects and initiatives’
• 2 Seminars
• Quality Strategy 2010 commitment to ‘Improve resources to support
better health literacy’.
• Resources on Medicines, TeachBack & (NES) Workforce
Development
• Self-Management
• Establishment of National Literacy Action Group
“ The impact of limited literacy skills on health has been
well documented, giving rise to a new field of study
termed health literacy.” – Wolf (2008)
Health literacy
Theory, models, approaches
What is health literacy?
In short:
“the ability to access, understand, and use
information for health”
Nutbeam (2000)
Unpacking this:
1. What is the relationship between literacy and
health literacy?
2. What is the focus of research in related fields?
3. What approaches are employed in tackling
health literacy?
Understanding literacy
Nutbeam:
• Literacy can be measured in absolute terms
(distinguishing between those who can read
and write basic texts and those who can’t);
• In relative terms by assessing the skill
differences between adults who are able to
perform relatively challenging literacy tasks
and those who are not.
• Literacies are context and content specific
e.g. health literacy
Greatest
application in
clinical care - a
risk to be
assessed and
managed through
adapted
communication/
environmental
modification
Greatest
application in
public health an asset to be
developed, as an
outcome to
health education
and
communication
What is the relationship between literacy and health literacy?
Nutbeam’s model of health literacy
• Functional literacy: basic literacy skills to function
effectively with regards to health and knowledge
• Interactive health literacy: independently obtain
relevant health information, derive meaning, and apply
information to health circumstances.
• Critical health literacy: ability to use information to
exert greater control over life events and situations
What is the relationship between literacy and health literacy?
What is the focus of research in related
fields?
• Links between literacy and health outcomes:
– Demands of the healthcare system including
self-management
– Inequalities: the lives of those with limited
literacy skills
• Health literacy as a public health outcome i.e.
education approaches
Health literacy population surveys
• National Consumer Council survey among 2,000
adults (2004).
• One in five people had problems with the basic skills
needed to understand simple information that could
lead to better health.
• Poorer sections of the community were less likely to
seek information or help for health problems.
Focus of research in related fields: The evidence
Literacy population surveys
Findings from the Scottish Survey of Adult Literacies 2009:
• 26.7 per cent may face occasional challenges and
constrained opportunities.
• Within this, 3.6 per cent face serious challenges in their
literacy practices.
• People who score lowest in all three categories are
considerably more likely to be 56-65.
• People from the 15% most deprived areas tend to have
lower scores.
Focus of research in related fields: The evidence
Self-management of long term conditions
Schillinger et al (2002) found:
• Diabetic retinopathy
– 36% of patients with low health literacy
– 19% of those with adequate skills.
• Optimal blood sugar control
– 20% of patients with low health literacy
– 33% of those with adequate skills.
Focus of research in related fields: The evidence
Self-management of long term conditions
Omachi et al (paper in preparation):
• Independent of race, income, and educational
attainment, poor health literacy is associated with
greater COPD severity and general health status...
• Attention to health literacy has the potential to
improve COPD self-management.
Focus of research in related fields: The evidence
Self-reported health and health-related
behaviour
• Poor physical and mental well-being is associated
with poor literacy and/or numeracy.
• Men with lower literacy levels who drank alcohol
were also more likely to consume a higher number
of units than those with good skills.
• They were more likely to smoke cigarettes.
New Light on Literacy and Numeracy in Scotland
Focus of research in related fields: The evidence
Health improvement interventions
Huizinga (2009):
• Lower literacy skills were associated with
less accuracy with poor portion-size
estimation skills.
• Opportunities may exist to improve portionsize estimation by addressing literacy.
Focus of research in related fields: The evidence
Medicine and adherence
• Wolf et al (2007) found that
46% of patients
misunderstood one or more
dosage instructions.
• Patients with low literacy
were less able to
understand instructions
compared to those with
adequate literacy.
Focus of research in related fields: The evidence
Measuring low literacy and low health
literacy
• Health literacy-related test instruments e.g
Newest Vital Sign, REALM, s-TOFHLA
• Testing of literacy skills
• Assessment/self-assessment based on
literacy-related practices e.g. the single
item screener: How often do you need to
have someone help you when you read
instructions, pamphlets, or other written
material from your doctor or pharmacy?
Focus of research in related fields: The evidence
The impact of communication
interventions
• For example, Ask Me 3
What is my main problem? What do I need to do?
Why is it important for me to do this?
• Galliher et al 2010: no significant difference between
the AM3 and control patients in the rate of asking
questions, but this rate was high (92%) in both groups.
• No evidence of better adherence to prescription
medications or lifestyle recommendations.
Focus of research in related fields: The evidence
What approaches are adopted in tackling
the issue?
•
Programmes of work to address inequalities
•
Rudd:
– Improve the literacy skills of the public
– Improve the communications skills of health care
staff
– Recalibrate the norm and identify literacy barriers
• Lower demands
• Remove barriers
What approaches are adopted in tackling the issue?
Health literacy as an outcome
• Education programmes incl. patient education
for long term conditions
• Public information and campaigns
• Accessible information policy and practice
• Communication interventions
What approaches are adopted in tackling the issue?
A dual focus
Weiss et al (2006)
• RCT with patients assigned either to
– an intervention group that receiving standard
depression treatment plus literacy education
– control group received standard depression treatment
• At final follow up depression severity was lower in
intervention group
• Literacy skills improved and their depression severity
lessened.
What approaches are adopted in tackling the issue?
“ I never knew help was out there
until I was asked… no one had ever
asked me before”
Woman aged 57,
referred to adult literacy learning through
Keep Well programme
Health Literacy is....
critical empowerment strategy to increase
people’s control over their health, their ability
to seek out information and their ability to
take responsibility.’
‘A
Bumpstart
• Aim - to improve health outcomes for pregnant
women and their families
• Target – pregnant women in North Edinburgh
• Development – partnership, funding, time and
assessment
Health Literacy Interventions
• Parent education classes
• Tier 1 – Mums Pregnancy Planner
Mums Clubs
• Tier 2 – Pregnancy Cafe
• Tier 3 – 1:1 literacy support
Health Literacy Interventions
• Parent education classes
• Tier 1 – Mums Clubs
Mums Pregnancy Planner
• Tier 2 – Pregnancy Cafe
• Tier 3 – 1:1 literacy support
Health Literacy Interventions
• Parent education classes
• Tier 1 – Mums Pregnancy Planner
Mums Clubs
• Tier 2 – Pregnancy Cafe
• Tier 3 – 1:1 literacy support
•
How can you identify who has low
‘Sorry I forgot my glasses’
health literacy?
• ‘I’ll take it home to read’
• Forms incorrectly completed
• Frequently missed appointments
• Non-compliance with treatment or medication regimes
Health Literacy Interventions
• Parent education classes
• Tier 1 – Mums Pregnancy Planner
Mums Clubs
• Tier 2 – Pregnancy Cafe
• Tier 3 – 1:1 literacy support
Kate’s experience of Bumpstart
Communication & Health Literacy
‘The biggest problem in communication is the
illusion that it has taken place.’
George Bernard Shaw
Communication strategies for
improving health literacy
• Ask if they understand
• Draw pictures
• Go over and repeat the information several times
• Write it down for them
• Give them a leaflet or suggest a useful website
Teach-back technique
• The only way to know for sure is to ask!
• Asking patients to explain or demonstrate in their
own words what they need to know or do
• Not a test for the patient
• Chance to check for understanding and re-teaching
if necessary
Teach–back evidence
•
•
•
•
Patient safety
Surgical informed consent
Chronic disease management
Asthma
Edinburgh GP using teach-back
‘I told a patient to have a blood test in 1 week and
phone 3 days later for the test results. I said if the
blood results were worse, I would see him that
week, if not, I would see him in a month. He told
me he understood, but when I did teach-back he
thought he had to see me in a week and get the
blood test in a month.’
‘Teach-back saves time in the longer term as it reduces
unnecessary follow up appointments, medication and
treatment errors. I’ve recommended it to all my GP
colleagues in the practice.’
Thank you!
Kate Burton
[email protected]
What next
• National Health Literacy Group – high impact
interventions
• What do you think will make the biggest difference?